Turning people into couch potatoes is not the cure for sports concussion

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Assessing golf and health, and investigating how the evidence base can impact policy and practice

Golf is a sport played by over 60 million people in over two-thirds of countries worldwide. This thesis contributes knowledge regarding what is known about golf and health, and what can be advised to maximise health benefits, and minimise the health dis-benefits of golf, and assesses the impact of this knowledge for the golf industry and policy makers. The first chapter describes the scientifically well-established longevity, physical and mental health benefits of regular physical activity, and provides background information on golf. Following this introductory chapter, this thesis first identifies, and then addresses some critical gaps in the literature on the associations between golf and health. The second chapter of the thesis presents a scoping review assessing the relationships between golf and health. Three hundred and one studies met inclusion criteria for the scoping review. The studies showed that golf can provide moderate intensity physical activity and is associated with health benefits that include improved cardiovascular, respiratory and metabolic profiles, and improved wellness. There is limited evidence relating to mental health, while regarding longevity there was some evidence for benefits of golf, but more robust studies are required. No measures of physical activity obtained by golf spectators had been reported. The third chapter of the thesis addresses one of the evidence gaps identified by the scoping review, this is the area with least existing evidence, and relates to physical activity (PA) obtained by spectators. An initial cross-sectional study of n=339 spectators at a 4-day 2016 UK golf tournament used pedometers and surveys to investigate PA behaviours and attitudes. Findings highlighted that obtaining exercise/PA can be a motivator to attend, and that spectators can engage in health-enhancing physical activity (HEPA) while at the event with 82.9% obtaining the recommended daily step count while spectating. A follow up study of n=135 spectators who responded to an online questionnaire three months post intervention showed that a 40.4% of spectators do self-report an increase in PA during the 3 months post intervention at a golf tournament. These are important findings as golf spectating has high global participation and potential for impact is therefore high. However, it is not yet clear if the results from these two novel studies are generalisable. Having conducted the scoping review, I identified the absence of coherent scientific advice to/for players, the golf industry, and policy makers. I aimed to address this in the fourth chapter of the thesis and describe the modified Delphi methods used to engage leaders at the intersection of health, sport, policy and golf to build a cross-sectoral consensus statement relating to golf and health. Consensus findings, and their implications for players, the golf industry and facilities and policy makers are described. Measuring the uptake, use and impact of research is imperative to demonstrate value to funders and employers, and to highlight and support further knowledge translation and decision-making efforts. The fifth chapter provides a novel Research Impact tool and utilises the established Research Contribution Framework to explore and explain the uptake, use and impact of the studies in this thesis. There is clear evidence that the work contained in this thesis has had wide uptake and use. Chapter 6 provides discussion of the thesis overall, analysing key findings, reflecting on strengths and weaknesses of the work, and making recommendations for policy, practice and future research. This thesis has assessed current knowledge regarding golf and health, conducted original research to address knowledge gaps, provided guidance to key stakeholders, and evaluated the uptake, use and impact of our work. The best available evidence highlights physical health, well-being and probable longevity benefits for golf participants. Health enhancing physical activity can also be achieved by spectators at professional golf tournaments. There is evidence of strong uptake and use of the research in this thesis. If practical recommendations contained in this thesis to i) golfers and potential golfers ii) the golf industry and facilities iii) policy makers iv) the scientific community, are adopted, this will contribute to increased inclusivity, and improved health through golf

Activation workers’ perceptions of their long-term unemployed clients’ attitudes towards employment

The Work Programme’s use of severe social security benefit sanctions reflects British coalition ministers’ belief that many people on out-of-work benefits do not want a job. While a substantial empirical literature has repeatedly demonstrated that in fact unemployed benefit claimants possess the same work values as the employed and that the vast majority want paid work, it has ignored some conservative authors’ pleas to consider the views and experiences of people who work with the unemployed. Forty employees of agencies contracted to help unemployed people into employment were interviewed in summer 2011. Respondents had spent an estimated combined total of 147,000 hours in the presence of people who have claimed Jobseeker’s Allowance (JSA) for over six months. Most said that between a quarter and half of their present clients did not want employment. This finding does not contradict existing research, given that most JSA claimants re-enter employment within six months. However, all forty agreed that many others remained unemployed because they were choosy in the jobs they were willing to undertake, and,most strikingly, respondents overwhelmingly endorsed the view that a ‘dependency culture’ exists in households and neighbourhoods that have experienced joblessness for several generations

Acute skin toxicity associated with a 1-week schedule of whole breast radiotherapy compared with a standard 3-week regimen delivered in the UK FAST-Forward Trial

BACKGROUND AND PURPOSE: FAST-Forward is a phase 3 clinical trial testing a 1-week course of whole breast radiotherapy against the UK standard 3-week regimen after primary surgery for early breast cancer. Two acute skin toxicity substudies were undertaken to test the safety of the test schedules with respect to early skin reactions. MATERIAL AND METHODS: Patients were randomly allocated to 40Gy/15 fractions (F)/3-weeks, 27Gy/5F/1-week or 26Gy/5F/1-week. Acute breast skin reactions were graded using RTOG (first substudy) and CTCAE criteria v4.03 (second substudy) weekly during treatment and for 4weeks after treatment ended. Primary endpoint was the proportion of patients within each treatment group with grade ⩾3 toxicity (RTOG and CTCAE, respectively) at any time from the start of radiotherapy to 4weeks after completion. RESULTS: 190 and 162 patients were recruited. In the first substudy, evaluable patients with grade 3 RTOG toxicity were: 40Gy/15F 6/44 (13.6%); 27Gy/5F 5/51 (9.8%); 26Gy/5F 3/52 (5.8%). In the second substudy, evaluable patients with grade 3 CTCAE toxicity were: 40Gy/15F 0/43; 27Gy/5F 1/41 (2.4%); 26Gy/5F 0/53. CONCLUSIONS: Acute breast skin reactions with two 1-week schedules of whole breast radiotherapy under test in FAST-Forward were mild

Healthcare systems data in the context of clinical trials - A comparison of cardiovascular data from a clinical trial dataset with routinely collected data

BACKGROUND: Routinely-collected healthcare systems data (HSD) are proposed to improve the efficiency of clinical trials. A comparison was undertaken between cardiovascular (CVS) data from a clinical trial database with two HSD resources. METHODS: Protocol-defined and clinically reviewed CVS events (heart failure (HF), acute coronary syndrome (ACS), thromboembolic stroke, venous and arterial thromboembolism) were identified within the trial data. Data (using pre-specified codes) was obtained from NHS Hospital Episode Statistics (HES) and National Institute for Cardiovascular Outcomes Research (NICOR) HF and myocardial ischaemia audits for trial participants recruited in England between 2010 and 2018 who had provided consent. The primary comparison was trial data versus HES inpatient (APC) main diagnosis (Box-1). Correlations are presented with descriptive statistics and Venn diagrams. Reasons for non-correlation were explored. RESULTS: From 1200 eligible participants, 71 protocol-defined clinically reviewed CVS events were recorded in the trial database. 45 resulted in a hospital admission and therefore could have been recorded by either HES APC/ NICOR. Of these, 27/45 (60%) were recorded by HES inpatient (Box-1) with an additional 30 potential events also identified. HF and ACS were potentially recorded in all 3 datasets; trial data recorded 18, HES APC 29 and NICOR 24 events respectively. 12/18 (67%) of the HF/ACS events in the trial dataset were recorded by NICOR. CONCLUSION: Concordance between datasets was lower than anticipated and the HSD used could not straightforwardly replace current trial practices, nor directly identify protocol-defined CVS events. Further work is required to improve the quality of HSD and consider event definitions when designing clinical trials incorporating HSD

Bridging the gap between low and high mass dwarf galaxies

While the dark matter content within the most massive giant and smallest dwarf galaxies has been probed -- spanning a range of over one million in mass -- an important observational gap remains for galaxies of intermediate mass. This gap covers K band magnitudes of approximately -16 > M_K > -18 (for which dwarf galaxies have B--K ~ 2). On the high mass side of the gap are dwarf elliptical (dE) galaxies, that are dominated by stars in their inner regions. While the low mass side includes dwarf spheroidal (dSph) galaxies that are dark matter-dominated and ultra compact dwarf (UCD) objects that are star-dominated. Evolutionary pathways across the gap have been suggested but remain largely untested because the `gap' galaxies are faint, making dynamical measurements very challenging. With long exposures on the Keck telescope using the ESI instrument we have succeeded in bridging this gap by measuring the dynamical mass for five dwarf galaxies with M_K ~ -17.5 (M_B ~ --15.5). With the exception of our brightest dwarf galaxy, they possess relatively flat velocity dispersion profiles of around 20 km/s. By examining their 2D scaling relations and 3D fundamental manifold, we found that the sizes and velocity dispersions of these gap galaxies reveal continuous trends from dE to dSph galaxies. We conclude that low-luminosity dwarf elliptical galaxies are dominated by stars, not by dark matter, within their half light radii. This finding can be understood if internal feedback processes are operating most efficiently in gap galaxies, gravitationally heating the centrally-located dark matter to larger radii. Whereas external environmental processes, which can strip away stars, have a greater influence on dSph galaxies resulting in their higher dark matter fractions. Abridged.Comment: 20 pages, includes 12 figures, accepted for publication in MNRA